RCI test request form

Form 1A 

Please use our test request form (PDF 186KB) to request the investigation of:

• Allo and autoantibodies
• Autoimmune haemolytic anaemia
• Haemolytic disease of the fetus and newborn (HDFN)
• Haemolytic transfusion reactions
• IgA deficiency

When crossmatched units or antibody identification results are required

Please specify a date and time for requesting, advising ‘ASAP’, ‘as soon as possible’ or ‘when ready’ means that we cannot prioritise work accurately.

We will discuss the request and the ability to supply to this time requirement, and offer alternatives should this not be possible. This may require a discussion with the on-call consultant.

• Refer to our guidance (PDF 633KB) 

Please label samples "urgent" only when there is a clinical need

Read our sample labelling policy in Clinical Guidelines for our requirements.

Send to lab promptly

We need to receive samples no more than four days after phlebotomy. Samples sent five, six or even seven days after phlebotomy mean they effectively become urgent samples. As testing samples urgently is less efficient than routine testing, our ability to identify and prioritise genuine clinically urgent cases is compromised. 

Fax confirmation is needed

When requesting a test / sending samples, please ensure fax (Word 49KB) to confirm. 

Ordering the form

Please contact your RCI laboratory if you need supplies of the form.